| NPI | 1215586839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: 044889) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: NY 044889) |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2023-05-10 |